Breast cancer patients' postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience

Abstract

Background: The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related quality of life (HRQoL) and patients' satisfaction in patients undergoing NSM and breast reconstruction with or without ADM.

Methods: Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with definitive implant and ADM (Group A), IBR only with definitive prosthesis (Group B), and two-stage breast reconstruction (Group C). The postoperative complications, BREAST-Q outcomes and reoperations were compared.

Results: A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8.3% in Group A, 2.9% in Group B and 5.7% in Group C. Postoperative infection occurred in two patients of Group A (5.6%), one patient of Group B (2.9%) and one of Group C (2.9%). Group A reported larger drain volume (1,125±243.5 cc), longer drain period (13.2±2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥50 years presented a higher score in "Satisfaction with breast" (P<0.001) and "Satisfaction with outcome" domains (P<0.05). Performing a bilateral breast reconstruction was associated to higher scores in "Physical wellbeing chest domain" (P<0.05). In addition, patients in Group A and Group B reported higher score in "Satisfaction with the breast" domain (P<0.001) but only in Group B we reported a higher score in "Satisfaction with outcome" (P<0.001).

Conclusions: Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The prepectoral placement of ADM could minimize complications and optimize aesthetic results.

Keywords: Acellular derma matrix (ADM); breast cancer (BC); breast reconstruction; nipple sparing mastectomy (NSM).

Figure 1

Study design. IBR, immediate breast reconstruction; ADM, acellular dermal matrix.

Figure 2

Preoperative drawings in standing position in a patient undergone bilateral NSM with “Lazy S” incision. NSM, nipple-sparing mastectomy.

Figure 3

Intraoperative image of a patient undergone unilateral NSM and IBR with ADM, showing the ADM sutured at the inferior border of the muscle. NSM, nipple-sparing mastectomy; IBR, immediate breast reconstruction; ADM, acellular dermal matrix.

Figure 4

Intraoperative image of a patient undergone unilateral NSM and IBR with ADM, showing ADM positioning. NSM, nipple-sparing mastectomy; IBR, immediate breast reconstruction; ADM, acellular dermal matrix.

Figure 5

Enrolled patients and drop-outs. QoL, quality of life.

Figure 6

Study groups. IBR, immediate breast reconstruction; ADM, acellular dermal matrix; QoL, quality of life.

Figure 7

Patient undergone NSM and IBR with ADM affected by major infection requiring reoperation. NSM, nipple-sparing mastectomy; IBR, immediate breast reconstruction; ADM, acellular dermal matrix.

Figure 8

Three months result of a patient undergone bilateral NSM and immediate reconstruction with ADM, front view with arms lowered. NSM, nipple-sparing mastectomy; ADM, acellular dermal matrix.

Figure 9

Three months result of a patient undergone bilateral NSM and immediate reconstruction with ADM, front view with arms raised. NSM, nipple-sparing mastectomy; ADM, acellular dermal matrix.

Figure 10

Three months result of a patient undergone bilateral NSM and immediate reconstruction with ADM and breast implant, side view. NSM, nipple-sparing mastectomy; ADM, acellular dermal matrix.